Reader response: Lipid levels and the risk of hemorrhagic stroke among women
Laurens F.Reeskamp, MD, PhD Candidate, Department of Vascular Medicine, Amsterdam UMC
Renate M.Hoogeveen, MD, PhD Candidate, Department of Vascular Medicine, Amsterdam UMC
Published July 01, 2019
Rist et al. showed that patients with low-density lipoprotein cholesterol (LDL-C) levels <70 mg/dL are at increased risk of intracranial hemorrhage (ICH).1 While fully acknowledging their results, we, however, deem a full appreciation of the clinical relevance of these numbers to be pivotal. Since LDL-C levels are causally related to cardiovascular disease (CVD) risk, findings should be balanced against the relative contribution of LDL-C in CVD risk in the study population. The Cholesterol Treatment Trialists’ Collaboration showed that every 10 mg/dL lowering of LDL-C reduces the annual CVD-risk by 1.03%.2 The overall CVD-risk in this cohort is reported to be 0.25% per year.3 We estimate that the low LDL-C group (<70 mg/dL) has a CVD-risk of 0.24% per year (53.7 mg/dL LDL-cholesterol below median in this cohort).3 The reported annual risk for ICH in the low LDL-C group is 0.04%. Therefore, the risk for CVD is approximately 6 times higher than the risk for ICH in this group.
Disclosures
The authors report no relevant disclosures. Contact journal@neurology.org for full disclosures.
References
Rist PM, Buring JE, Ridker PM, et al. Lipid levels and the risk of hemorrhagic stroke among women. Neurology 2019;92:e2286–e2294.
Cholesterol Treatment Trialists’ (CTT) Collaboration, Baigent C, Blackwell L, et al. Efficacy and safety of more intensive lowering of LDL cholesterol: A meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet 2010;376:1670–1681.
Ridker PM, Rifai N, Rose L, Buring JE, Cook NR. Comparison of C-Reactive Protein and Low-Density Lipoprotein Cholesterol Levels in the Prediction of First Cardiovascular Events. N Engl J Med 2002;347:1557–1565.
Rist et al. showed that patients with low-density lipoprotein cholesterol (LDL-C) levels <70 mg/dL are at increased risk of intracranial hemorrhage (ICH).1 While fully acknowledging their results, we, however, deem a full appreciation of the clinical relevance of these numbers to be pivotal. Since LDL-C levels are causally related to cardiovascular disease (CVD) risk, findings should be balanced against the relative contribution of LDL-C in CVD risk in the study population. The Cholesterol Treatment Trialists’ Collaboration showed that every 10 mg/dL lowering of LDL-C reduces the annual CVD-risk by 1.03%.2 The overall CVD-risk in this cohort is reported to be 0.25% per year.3 We estimate that the low LDL-C group (<70 mg/dL) has a CVD-risk of 0.24% per year (53.7 mg/dL LDL-cholesterol below median in this cohort).3 The reported annual risk for ICH in the low LDL-C group is 0.04%. Therefore, the risk for CVD is approximately 6 times higher than the risk for ICH in this group.
Disclosures
The authors report no relevant disclosures. Contact journal@neurology.org for full disclosures.
References